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John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

We’re getting more and more stories coming out about the impact for bad that an EHR can have in medicine. Most of them have been anecdotal stories like The Old Man and the Doctor Fable and Please Choose One. However, today I came across one that talked about an overdose due to an error in the use of EHR. Here’s a summary of the discovery:

Levitt’s supervising nurse was stumped, too, so they summoned the chief resident in pediatrics, who was on call that night. When the physician arrived in the room, he spoke to and examined the patient, who was anxious, mildly confused, and still complaining of being “numb all over.”

At first, he was perplexed. But then he noticed something that stopped him cold. Six hours earlier, Levitt had given the patient not one Septra pill—a tried-and-true antibiotic used principally for urinary and skin infections — but 38½ of them.

Levitt recalls that moment as the worst of her life. “Wait, look at this Septra dose,” the resident said to her. “This is a huge dose. Oh my God, did you give this dose?”

“Oh my God,” she said. “I did.”

If you read the whole article linked above, you’ll discover that the issue happened when entering the dosage for a drug into the Epic EHR system at UCSF. I’m not here to point fingers since every case is unique and you could argue forever about whether it’s the software’s responsibility to do something or whether the person using the software is responsible for understanding how the software works. I think that’s a discussion that goes nowhere since the right answer is that both can do better.

These types of stories are heartbreaking. They even cause some to question whether we should be going electronic at all. I’m reminded of a time I was considering working at a company that did expert witness testimony for cars. One of their hypothesis was that the computers that are now found in cars will usually save people’s lives. However, in a few cases they’re going to do something wrong and someone is going to lose their life. I think that’s where we’re at with EHR software. It’s not perfect and maybe never will be, but does it save more lives than it kills?

That’s a tough question that some people don’t want to face, but we’re going to face it whether we acknowledge the question or not. Personally, I think the answer to that question is that we do save more lives with an EHR than we damage. In the case above, there were still a lot of humans involved that could have verified and corrected the mistake with the EHR. They didn’t, but they could have done so and likely do with hundreds of other mistakes that occur every day. This human touch is a great counterbalance to the world of technology.

If we expanded the discussion beyond lost lives, it would be a much more challenging and complex discussion to know if EHR makes an organization more or less productive. I believe in the short term, that discussion is up for debate. However, in the long term I’m long on the benefits of EHR when it comes to productivity.

None of this should excuse us from the opportunity to learn important lessons from the story above. We need to be careful about over reliance on data in the EHR (similar to over reliance on a paper chart). We need to make our EHR smarter so that they can warn us of potential problems like the ones above. We need EHR vendors to not let known EHR problems remain unfixed. We need a solid testing plan to avoid as many of these situations as possible from ever happening in the first place.

There’s a lot of work to do still to improve EHR. This story is a tragic one which should remind us all of the important work we’re doing and why we need to work really hard to improve it now.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I came across this tweet and it made me stop and realize how important the selection and more important the implementation of your EHR will be for your organization. In many areas there’s already a nurse shortage, so it would become even more of an issue if your hospital comes to be known as the hospital with the cumbersome EHR.

Here’s some insight into the survey results from the article linked above:

79% of job seeking registered nurses reported that the reputation of the hospital’s EHR system is a top three consideration in their choice of where they will work. Nurses in the 22 largest metropolitan statistical areas are most satisfied with the usability of Cerner, McKesson, NextGen and Epic Systems. Those EHRs receiving the lowest satisfaction scores by nurses include Meditech, Allscripts, eClinicalWorks and HCare.

The article did also quote someone as saying that a well done EHR implementation can be a recruiting benefit. So, like most things it’s a double edge sword. A great EHR can be a benefit to you when recruiting nurses to your organization, but a poorly done, complex EHR could drive nurses away.

I’m pretty sure this side affect wasn’t discussed when evaluating how to implement the EHR and what kind of resources to commit to ensuring a successful and well done EHR implementation. They’re paying the price now.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was intrigued by a report by the Center for New American Security that was covered in this article on HealthcareDive. In the report, they make a good case for why the Department of Defense (DOD) should select an open source EHR solution as opposed to a commercial solution. Here’s an excerpt from the article:

“I think the commercial systems are very good at what they do,” Ondra said. However, “they are not ideally designed for efficiency and enhancement of care delivery, and I think the DOD can do better with an open source system both in the near-term, and more importantly in the long-term, because of the type of innovation and creativity that can more quickly come into these systems.”

Reports like this make a pretty good case for open source. Plus, I love that it also pointed out that commercial EHR vendors were built on the back of the fee for service model which doesn’t matter to the DOD. It was also interesting to think about the DOD’s selection of an open source EHR system as an investment in other hospitals since the money they spend on an open source EHR could help to catalyze the ongoing development of a free open source EHR solution.

While these arguments make a lot of sense, it seems that the DOD has decided not to go with an open source EHR solution and instead is opting for a commercial alternative. In this article (Thanks Paul) the DOD has narrowed the list of contenders for the $11 Billion DOD EHR contract (DHMSM) to just: CSC/HP/Allscripts, Leidos/Accenture/Cerner, and IBM/Epic who “fall within the competitive range.” They reported that PwC/Google/GDIT/DSS/Medsphere and Intersystems did not fall within the competitive range.

I’ll be interested to hear Medsphere’s take on this since every report I’ve ever read has Medsphere and their open source Vista solution as much less expensive than the commercial alternatives (Epic, Cerner, Eclipsys). So, I can’t imagine that the Medsphere bid was so much more than the others. Unless the consultants are charging through the nose for it. Or maybe the open source Vista option wasn’t “in the competitive range” because it was too cheap. Wouldn’t that be hilarious to consider. Hopefully the government isn’t that stupid, but…

I don’t claim to have any clue on how these $11 billion government contract bids work. I’m just a casual observer from the sideline. It seems like 3 companies remain in the ring. I guess the Google juice wasn’t enough for the PwC/Medsphere bid.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The Kansas City Star is reporting that Cerner is offering employers whose combination of years of service and age total 65 have been offered voluntary separation packages. Here’s an excerpt from the article:

Cerner spokesman Dan Smith said the one-time offer reflects the “deep bench of complementary talent” because of the Siemens acquisition and doesn’t affect Cerner’s continued hiring or its future growth plans.

“This is a truly voluntary program for all of our U.S. associates,” Smith said. “There is no pre-determined outcome and no number to hit. It provides eligible associates who might be ready to make a change the chance to decide to stay or pursue a different option and get benefits not normally associated with voluntary departures.”

With any large acquisition like the one Cerner did of Siemens, there has to be a lot of duplicate functions and they have to look at how to trim back the number of employees. So, this shouldn’t come as any surprise. In fact, I think the fact that they’re currently doing a voluntary separation package might mean that they aren’t looking to slim down the company as much as you’d think. Some investors might think that’s a bad plan since every company the size or Cerner or Siemens (let alone the combined company) could likely fire 10% of the workforce and improve their company’s profitability. Although, it could also be a sign of how much growth Cerner is experiencing.

Personally, I’ll be watching to see if they announce some other layoffs. It will be a surprise to me if they don’t announce some involuntary layoffs. Either way, this is a normal part of an acquisition like this.

It does make me wonder how many of these older professionals that accept the voluntary separation packages will end up at the wide variety of EHR consulting companies out there. You have to think that would be a pretty sweet deal for them.

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Recently, consulting giant Deloitte announced a new program, named “Evergreen,” designed to cut down the cost of implementing and operating hospital EHRs. Unfortunately, much of the Evergreen coverage in the health IT trade press was vague or downright wrong, as it suggested that Deloitte was actually going into the EHR business itself. The key point Deloitte sought to make — that it could implement and operate EHRs for 20% to 30% less than hospitals — did come across, but the rest was a bit jumbled.

Having spoken to Mitch Morris, global healthcare leader for Deloitte Consulting LLP, I can clarify much of what was confusing about the Evergreen announcement and subsequent coverage. Here’s some key points I took away from my chat with Morris:

Evergreen is a suite of services, not a product: Though some HIT editors seem to have been confused by this, Evergreen isn’t an EHR offering itself. It’s a set of EHR implementation and operation services provided by Deloitte Consultants. Evergreen also includes a financing scheme allowing hospitals and health systems to obtain a new EHR by making a series of equal payments to Deloitte over five to seven years. (“It’s like leasing a car,” Morris noted.) This allows hospitals to get into the EHR without making an enormous upfront capital investment over the first 18 months.

Evergreen is only offered in tandem with an Epic purchase: The Evergreen program arose from what Deloitte learned after doing a great deal of work with Epic EHRs, including the famous multi-billion install at Kaiser Permanente and an extensive rollout for large hospital system Catholic Health Initiatives. So at the outset, the program is only available to hospitals that want to go with Epic. Deloitte is considering other EHR vendors for Evergreen partnership but has made no decisions as to which it might add to the program.

Both onshore and offshore services are available through Evergreen: One might assume that Deloitte is offering lower implementation and operation costs by offshoring all of the work. Not so, Morris says. While Deloitte does offer services based in India and Ireland, it also taps U.S. operations as needed. Clients can go with offshore labor, onshore labor or a mix of services drawing on both.

This is a new application services management offering for Deloitte: While the consulting giant has been managing Oracle and SAP installations for clients for some time, managing EHR platforms is a new part of its business, Morris notes.

According to Morris, Deloitte expects Evergreen customers to include not only health systems and hospitals that want to switch EHRs system-wide, but also those which have done some acquisitions and want to put all of their facilities on the same platform. “It’s expensive for a health system to maintain two or three brands, but they often can’t afford the upfront capital costs of putting every hospital on the same EHR,” he said. “We smooth out the costs so they can just make a payment every month.”

This could certainly be a big score for Epic, which is likely to scoop up more of the EHR-switching systems if Deloitte helps the systems cope with the costs. And Deloitte is likely to get many takers. Let’s see, though, whether it can actually follow through on the savings it promises. That could change the EHR game as we know it.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The Wisconsin State Journal is reporting that Epic is working on the Epic App Store which will be called the Epic App Exchange. I guess the news was mentioned by Mark Bakken, co-founder and former chief executive of Nordic Consulting, at a Wisconsin Innovation Network event and confirmed by Shawn Kiesau, Epic spokesman. Here’s a quote from the article:

Bakken said the app store will launch in a few weeks and it will “open the floodgates” for all sorts of companies to develop and market their apps, especially those in the Madison area populated by former Epic employees.

“We think Epic is big now? This will cement their long-term legacy. It’s exactly the right thing to do,” Bakken said later in an interview.

Bakken has obviously drunk the Epic Kool Aid having created a very large Epic consulting firm in Madison and he’s now creating an investment fund called HealthX Ventures that’s focused on healthcare IT startups with many of them created by former Epic employees. He is right that an Epic app store with a robust API could be an awesome opportunity for Epic and entrepreneurs.

What’s not clear to me from this initial news is how open the Epic app store will really be. If it’s like their previous Epic API, it wasn’t much to write about. It didn’t allow an app to integrate deeply with the Epic system. Will we once again be disappointed by the Epic App Store, or will they start to really open up Epic to entrepreneurs who want to build applications on top of their systems?

My gut tells me that the former is more likely. This actually puts people like Bakken with deep relationships with Epic at a real advantage. My bet is that Epic will only work with companies and organizations that they trust and so these already existing relationships could become even more valuable. While it’s true that Epic should be careful with how they work with external companies that want to leverage the new Epic app store, there are ways they can protect their customers and patient data while still opening up their application to entrepreneurs of every kind. We’ll see if I’m wrong about this. Maybe they will really open things up, but I’m skeptical that they’ll be able to overcome their fear (unfounded as it may be).

In the article linked above, Bakken is quoted as saying that “he expects the first apps to come from Epic’s customer.” This would confirm my prediction above that Epic will be afraid to really open up its platform to entrepreneurs and instead will focus the app store on their closed customer ecosystem. Even the name “Epic App Exchange” hints at this being the case. They want their customers to exchange apps. They aren’t looking to create a true app store where entrepreneurs can innovate on top of Epic’s base.

Of course, since Epic doesn’t like to work with the media very much, it’s hard to know what the Epic App Store will really look like when it’s launched. This is a step in the right direction for Epic. I just still don’t think Epic understands the opportunity that they have to really improve healthcare and solidify themselves as the go to leader in healthcare IT. I’ll continue to hope I’m wrong and Epic will blow us away with the official announcement and details of a really open app store and API.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As I read through all of the coverage of the announcement, John Halamka seems to have shifted gears from their current in house EHR approach to now considering a switch to some other external EHR vendor. This is very interesting given this blog post by John Halamka back in 2013. Here’s an excerpt from it:

Beth Israel Deaconess builds and buys systems. I continue to believe that clinicians building core components of EHRs for clinicians using a cloud-hosted, thin client, mobile friendly, highly interoperable approach offers lower cost, faster innovation, and strategic advantage to BIDMC. We may be the last shop in healthcare building our own software and it’s one of those unique aspects of our culture that makes BIDMC so appealing.

The next few years will be interesting to watch. Will a competitor to Epic emerge with agile, cloud hosted, thin client features such as Athenahealth? Will Epic’s total cost of ownership become an issue for struggling hospitals? Will the fact that Epic uses Visual Basic and has been slow to adopt mobile and web-based approaches provide to be a liability?

Or alternatively, will BIDMC and Children’s hospital be the last academic medical centers in Eastern Massachusetts that have not replaced their entire application suite with Epic?

Based on John Halamka’s comments it seems that his belief might have changed or at least he’s considering the option that an in house system is not the right approach moving forward. No doubt Athenahealth is hoping that they’ll delay the decision a few years so they have a chance to compete for BIDMC’s business.

If you look at the rest of the blog post linked above, Halamka was making the case for Epic back in 2013. I think that clearly makes Epic the front runner for the BIDMC business at least from Halamka’s perspective. We’ll see how that plays out over time.

It seems like we’re nearing the end of the in house EHR hospital. Are there any others that still remain?

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As most regular readers know, we don’t try to get into the rat race of breaking news on things like EHR selection, the latest meaningful use, or whatever else might be time sensitive healthcare news. Sure, every once in a while we’ll report something we haven’t seen or heard other places, but we’re more interested in the macro trends and the broader insight of what various announcements mean. We don’t want to report on something happening, but instead want to tell you why something that happened is important.

A great example of this is Mayo Clinic’s decision to go with Epic and leave behind Cerner, GE, and other systems. There’s a good interview with Mayo Clinic CEO, Cris Ross, that talks about Mayo’s decision to go with Epic. As he says in the interview, GE Centricity wasn’t part of their future plans, and so they were really deciding between Epic and Cerner. Sad to see that Vista wasn’t even part of their consideration (at least it seems).

Based on Cris Ross’ comments, he commented that he liked Epic’s revenue cycle management and patient engagement options better than Cerner. Although, my guess is that they liked Epic’s ambulatory better than Cerner as well since they were going away from GE Centricity. Cris Ross’s double speak is interesting though:

As we looked at what met our needs, across all of our practices, around revenue cycle and our interests around patient engagement and so on, although it was a difficult choice, in the end it was a pretty clear choice that Epic was a better fit.

Either it was a difficult choice or it was a pretty clear choice. I think what Cris Ross is really saying is that they’d already decided to go with Epic and so it was a clear choice for them, but I better at least throw a dog bone to Cerner and say it was a hard choice. Reminds me of the judges on the voice that have to choose between two of their artists. You know the producers told them to make it sound like it’s a hard choice even if it’s an easy one.

Turns out in Mayo’s case they probably need to act like it was a really hard choice and be kind to Cerner. Mayo has been a Cerner customer for a long time and the last thing they want to do is to anger Cerner. Cerner still holds a lot of Mayo’s data that Mayo will want to get out of the Cerner system as part of the move to Epic.

I’ll be interested to watch this transition. Will Cerner be nice and let Mayo and their EHR data go easily? Same for GE Centricity. I’ve heard of hundreds of EHR switches and many of them have a really challenging time getting their data from their previous EHR vendor. Some choose to make it expensive. Others choose to not cooperate at all. Given Mayo’s stature and the switch from Pepsi to Coke (Cerner to Epic, but I’m not sure which is Pepsi and which is Coke), I’ll be interested to see if Cerner lets them go without any issues.

I can’t recall many moves between Epic and Cerner and vice versa. Although, we can be sure that this is a preview of coming attractions. It will be interesting to see how each company handles these types of switches. What they do now will likely lay the groundwork for future EHR switching.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

When you dig into the details of the acquisition, you realize that Athenahealth isn’t going to sell the webOMR software. They’ve purchased the right to be able to copy what’s been built into that EHR software and no doubt bake it into the RazorInsights software. Plus, they’ll have the people at BIDMC providing feedback and guidance as Athenahealth builds out a full inpatient EHR platform that can compete with Epic and Cerner. Jonathan Bush makes it clear that it’s going to take a couple years to make this full vision come to pass, but he believes building it on the right technology will make all the difference as they go after the inpatient EHR market.

I have to admit that I think KLAS got it right when they said that this deal is really about Athenahealth going to inpatient EHR school:

No doubt this was also a way for Athenahealth to get into BIDMC in order to sell their ambulatory software. As part of the deal they’re starting the rollout of Athenahealth ambulatory EHR to a few of their clinics. It will be interesting to hear how that goes since it will say a lot about how the future BIDMC partnership will go for Athenahealth. No doubt, Athenahealth is going to throw all of its resources at the implementation to make sure they’re a success.

This move by Athenahealth is a big one and fraught with risk. It combines the complicated hospital environment with an existing software base and the acquisition of another software base as they integrate a third software base’s experience into a new platform for inpatient EHR. Yeah, nothing could go wrong with that mix. Of course, in a high stakes game of poker when there’s a lot of risk, there’s a lot of reward. Jonathan Bush and Athenahealth have pushed their chips all in. We’ll see the final card in about 2-3 years.

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

As we first wrote about back in August 2014, Cerner Has Acquired Siemens and today the acquisition is complete. Here’s a quote from Neal Patterson, Cerner Chairman CEO and Co-Founder, about the acquisition:

“By combining client bases, investments in R&D and associates, we are in a great position to lead clients through one of the most dynamic eras in health care,” said Neal Patterson, Cerner chairman, CEO and co-founder. “Cerner remains focused on key development areas including population health, physician experience, open platforms, revenue cycle and mobility. We see these as critical areas of investment to ensure providers can meet growing regulatory demands and control costs, while continuing to improve quality of care.”

This note on Cerner revenue and client base was quite interesting: “Cerner expects revenue in 2015 to be approximately $4.8 billion to $5 billion, with a client base spanning more than 30 countries across more than 18,000 facilities.” For those keeping track at home, the purchase price for the acquisition was $1.3 billion plus working capital adjustments.

We wrote previously about John Glaser staying on at Cerner. Cerner has committed to supporting and advancing the Soarian platform for at least the next decade. Although, that’s not a surprise since it will probably take a decade for the Soarian licenses to come up for renewal so they can move them to the Cerner platform.

Give it 3-4 years and you’ll see why Soarian is not likely to be a long term option for organizations. It’s expensive to support 1 platform, let alone two. Cerner will be doing the minimum necessary on Soarian and integrating new revenue streams into it. Otherwise, I can’t imagine they’ll do anything great with it.

The next couple years are going to get really interesting as the two heavyweights battle it out: Cerner and Epic. Although, I thought Neal’s areas of interest for Cerner were interesting: population health, physician experience, open platforms, revenue cycle and mobility. I’d love to sit down with him and talk about what they’re really doing in these areas. Especially around open platforms.